Acupuncture Fights Gulf War Illness, US Department of Defense

18 October 2016

A randomized clinical study from the New England School of Acupuncture (NESA) has proven the efficacy of acupuncture for the treatment of pain for patients with Gulf War Illness (GWI). Of the 85 subjects who completed the study, there was an average improvement of 9.4 points in the physical function of the test group and a pain reduction of 3.6 points. (Results were measured using the 36-Item Short Form Survey for physical function (SF-36P) and the McGill Pain Scale, and they were modeled using a generalized estimating equation (GEE) to determine correlation.) [1] Additionally, 96% of participating veterans reported the high usability of acupuncture and confidence in recommending it to a friend or family member. [2] Based on these results we can conclude that individualized treatment has provided significant relief in pain and physical disability for veterans with GWI.

The project was conducted by researchers from the University of Florida (Gainesville), Boston Veterans Healthcare System (Massachusetts), University of Texas (Austin), and the New England School of Acupuncture (Massachusetts). Funding for the research was provided by the US Department of Defense through the Congressionally Directed Medical Research Programs (CDMRP). The research award was supported by the Office of the Assistant Secretary of Defense for Health Affairs through the Gulf War Illness Research Program.

GWI is a Chronic Multisystem Illness (CMI) defined by the Center for Disease Control (CDC) as: “the report by a veteran of one or more chronic unexplained symptoms (present for 6 months or longer) in at least two of the following categories: [1] Fatigue. [2] Mood and cognition (symptoms of feeling depressed, difficulty in remembering or concentrating, feeling moody, feeling anxious, trouble in finding words, or difficulty in sleeping). [3] Musculoskeletal (symptoms of joint pain, joint stiffness, or muscle pain).” [3]

Veterans with GWI may also experience comorbid symptoms such as fibromyalgia, irritable bowel syndrome (IBS), digestive complaints, and mood disorders including: depression, post traumatic stress disorder (PTSD), and anxiety disorders. [4] GWI is known to be complex and poorly understood; its presentation is highly individualized and the symptoms are remarkably stable at 5 and 10 year follow-ups despite conventional medical treatments. [5]

Subjects included in this study were deployed to the Gulf Theater (as defined by 38 CFR 3.317) during the years 1990 – 1991, and have GWI as defined by the CDC. The reasons for excluding potential subjects included: an inability to complete the protocol, having another disease that could account for symptoms, and severe psychiatric illness. [6] The subjects were randomized into two groups; the first group received acupuncture twice a week for 6 months, and the second group went on a wait-list for 2 months, followed by weekly acupuncture treatments for 4 months. This test was designed with an active control group to maximize internal validity as well as to provide preliminary data on minimal effective dosage for treatment. [7] The acupuncturists chosen to conduct the study practiced at thirty treatment sites within 100 miles of the study offices; this design allowed the veterans to receive treatment near where they live and work, and was chosen to improve adherence to the treatment protocol.

While this study specifically tests how acupuncture improves physical function and pain using the well-validated SF-36P and McGill Pain scales, there are many studies that address the efficacy of acupuncture for the treatment of other aspects of GWI, as well as commonly comorbid symptoms.

Fatigability is one of the three major symptoms of GWI. Patients who suffer from chronic fatigue as a symptom of GWI experience fatigue for at least a day after exertion, and these symptoms last for at least 6 months. [8] Researchers at Taihe Hospital, in affiliation with Hubei University of Chinese Medicine, conducted a study to test the efficacy of acupuncture in the treatment of patients with Chronic Fatigue Syndrome (CFS), which they defined as at least 6 months of persistent or recurrent fatigue that is debilitating and not relieved by sleep. They found that acupuncture alone had an 80% success rate, and acupuncture with interferential current therapy (ICT - the high frequency electrical stimulation of acupoints) was 93.3% effective. A total of 20% of patients who received acupuncture, and 43.3% of patients who received acupuncture with ICT, experienced a complete recovery of their fatigue. [9] Lu et al. conducted randomized controlled clinical trials of acupuncture and moxibustion (burning of mugwort at acupoints) for the treatment of CFS and found that acupuncture with moxibustion had a success rate of 72.7% for patient satisfaction; this test group saw both physical and mental improvements. [10] Additionally, a study published in the Guangxi Medical Journal demonstrates that Qihuan acupuncture (the application of 8 needles to the abdomen evenly surrounding the naval) is more effective than conventional acupuncture. The researchers found that conventional acupuncture had a success rate of 80.85%, while Qihuan acupuncture proved to be 95.83% effective for the treatment of CFS. [11]

The second major category of symptoms in GWI is mood and cognition disorders; this includes: depression, irritability, difficulty thinking or concentrating, anxiety, difficulty finding words, and trouble falling asleep. [12] Acupuncture has been shown to be effective for a number of these disorders individually. Chronic fatigue may be compounded by the inability to fall asleep. A single-blinded, randomized, placebo-controlled study was conducted to test the efficacy of acupuncture and traditional Chinese herbs against the conventional treatment of estazolam, a benzodiazepine, in the treatment of sleep disorders. The acupuncture test group experienced an improvement in their daytime energy as well as a restoration of their sleep; 54.8% of patients recovered completely and another 35.5% improved significantly. The group taking estazolam had a 32.3% recovery rate and a 22.5% significant improvement rate, but they also had adverse side effects not experienced by the acupuncture group including fatigue, headaches, dry mouth, and dizziness. [13]

Some of the cognitive disorders experienced by veterans with GWI have been linked to a chronic dysfunction of hippocampal perfusion. A dysfunction of the hippocampus is linked to memory loss, confusion, irritability, and movement disorders. Some epidemiological studies have indicated that this may have been caused by exposure to neurotoxic chemicals used during the Gulf War. [14] While there has not yet been a study that addresses the use of acupuncture to treat the hippocampal dysfunctions specific to GWI, researchers using fMRI to study patients with Alzheimer's disease have found that acupuncture can enhance connectivity in both frontal and lateral regions of the hippocampus. [15] More research is necessary to confirm whether acupuncture can also improve cognitive disorders caused by neurotoxins.

Acupuncture has also been proven to treat certain symptoms that are commonly comorbid with GWI, including Irritable Bowel Disorder (IBD) and Irritable Bowel Syndrome (IBS). Research shows that electroacupuncture (the stimulation of acupoints with electricity) can act on the sympathetic nervous system and thus regulate peristalsis and suppress IBD. A meta-analysis of 11 research studies concluded that acupuncture with moxibustion has more clinical efficacy, and is safer, than pharmaceuticals used to treat IBS. [16] A study conducted at Heilongjiang University of Chinese Medicine compared the efficacy of electroacupuncture compared to pinaverium bromide. They demonstrated that electroacupuncture had an 86.7% rate of efficacy, versus 50% for the drug group.

Many studies have shown the efficacy of acupuncture for the treatment of pain. However, this study is especially important because it shows the efficacy of acupuncture in relieving the pain and physical symptoms of veterans suffering from GWI, a syndrome for which no standard of care currently exists. Hopefully, with this new and conclusive data, acupuncture can be incorporated into a treatment protocol which helps alleviate the pain and the myriad other symptoms associated with service in the Gulf War.